Adrenocorticotropin independent macronodular adrenocortical hyperplasia (AIMAH)
Diagnosis certain
Updates to Case Attributes
Status
changed from pending review to published (public).
Published At
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.
Presentation
was changed:
Patient admitted to the hospital after neck abscess drainage with fatigue, dyspnea and back pain.
On physical exam patient had hypertension (TA - 180/110 mmHg), tachycardia (110 bpm) and typical signs of Cushnig syndrome: moon face, striae, hirsutism and central obesity (BMI - 37, waist circumference - 120 cm). Patient also had hyperkyphosis.
Patient had, and a 5-year year history of type 2 diabetes mellitus, that was treated with 1000 mg of metformin and chronic hepatitis C.
Body
was changed:
Laboratory data:
- Serum glucose (on admission) - 15.90 mmol/L
- HbA1c - 7.40 %
- C-peptide - 3.09 ng/mL
- Cortisol (8.00) - 14.8 µg/dl
- Cortisol (22.00) - 14.2 µg/dl
- 24h Cortisol in urine - 777 µg
- AKTH < 1.00 pg/ml
Brain MRI showed no evidence of pituitary microadenoma.
Patient underwent laparoscopic left side adrenalectomy
Pathologist conclusion was:
- Macroscopically: received tissue material is cut in small pieces, excision line and fatty capsule is difficult to visualize. Tissue size 13x11 cm, bright yellow in color.
- Microscopically: Adrenal cortical clear cell adenomas, with solid, trabecular composition, lacunar hemorrhages and some amount of fibrosis in stroma. Capsule intact. ICD-O code: M8370/0
- No special immunohistological tests was performed
-<p>Laboratory data:</p><p>Serum glucose (on admission) - 15.90 mmol/L</p><p>HbA1c - 7.40 %</p><p>C-peptide - 3.09 ng/mL</p><p>Cortisol (8.00) - 14.8 µg/dl</p><p>Cortisol (22.00) - 14.2 µg/dl</p><p>24h Cortisol in urine - 777 µg</p><p>AKTH < 1.00 pg/ml</p><p>Brain MRI showed no evidence of pituitary microadenoma.</p><p>Patient underwent laparoscopic left side adrenalectomy</p><p>Pathologist conclusion was:</p><p>Macroscopically: received tissue material is cut in small pieces, excision line and fatty capsule is difficult to visualize. Tissue size 13x11 cm, bright yellow in color. <br>Microscopically: Adrenal cortical clear cell adenomas, with solid, trabecular composition, lacunar hemorrhages and some amount of fibrosis in stroma. Capsule intact. ICD-O code: M8370/0</p><p>No special immunohistological tests was performed</p>- +<p>Laboratory data:</p><ul>
- +<li>Serum glucose (on admission) - 15.90 mmol/L</li>
- +<li>HbA1c - 7.40 %</li>
- +<li>C-peptide - 3.09 ng/mL</li>
- +<li>Cortisol (8.00) - 14.8 µg/dl</li>
- +<li>Cortisol (22.00) - 14.2 µg/dl</li>
- +<li>24h Cortisol in urine - 777 µg</li>
- +<li>AKTH < 1.00 pg/ml</li>
- +</ul><p>Brain MRI showed no evidence of pituitary microadenoma.</p><p>Patient underwent laparoscopic left side adrenalectomy</p><p>Pathologist conclusion was:</p><ul>
- +<li>Macroscopically: received tissue material is cut in small pieces, excision line and fatty capsule is difficult to visualize. Tissue size 13x11 cm, bright yellow in color. </li>
- +<li>Microscopically: Adrenal cortical clear cell adenomas, with solid, trabecular composition, lacunar hemorrhages and some amount of fibrosis in stroma. Capsule intact. ICD-O code: M8370/0</li>
- +<li>No special immunohistological tests was performed</li>
- +</ul>
Diagnostic Certainty
was set to
.
Tags changed:
- endocrine
- general surgery
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